ITSF
INDONESIA TORAY SCIENCE FOUNDATION
SCIENCE AND TECHNOLOGY AWARD
2013
GUIDELINES FOR NOMINATION FOR THE ITSF SCIENCE & TECHNOLOGY AWARD
1. Qualifications of Candidates
The Award is open to Indonesians residing in Indonesia and pursuing research in the
field of Science & Technology, excluding mathematics, clinical medicine, and social
sciences, who had made a significant breakthrough to scientific knowledge.
2. ITSF Science & Technology Award
The ITSF Science & Technology Award for 2013 will consist of a certificate and a
prize of Rp. 75 millions.
3. Nomination of Candidates
A candidate should be nominated by a representative of a scientific research
institution or an institution of higher learning. No direct application of candidates will
be considered. The representative of the nominating institution is encouraged to
proactively seek suitable candidates and provide sufficient justification for the
nomination. The representative should be the Chairman of the Research Institute /
The Dean of the Faculty of a University or The Director of a Research Center for nonuniversity institutions.
4. Nomination Procedure
Candidates should complete the nomination form supplied by ITSF and send 5 (five)
copies of the completed form including any attachments after nicely bound with a
transparent plastic cover to ITSF at the mailing address stated herein.
5. Deadline
The completed forms should reach the foundation on or before 31 August 2013.
6. Selection Mechanism
The awardee will be selected by the following Selection Committee members:
Prof. Dr. Ir. Dedi Fardiaz, M. Sc
Dr. Debbie S Retnoningrum
Prof. Dr. Anung Kusnowo
Experts outside the
selection process.
Selection
(Chairman)
(Member)
(Member)
Committee may be requested to assist in the
An interview of short listed candidates may be carried out.
The decision of the foundation is final and no correspondence regarding the decision
will be entertained.
7. Presentation of the Award
The presentation ceremony for the ITSF Science and Technology Award for 2012 is
scheduled for February 2014.
Notes:
a) Candidates need not necessarily be a member of the nominating
institution.
b) Please write e-mail, phone or fax to ITSF at the address/numbers stated
below for additional information and clarification.
c) The Award is not taxable on part of the awardee.
Mailing Address/Enquiries to:
INDONESIA TORAY SCIENCE FOUNDATION
Summitmas II - 3rd Floor
Jl.Jenderal Sudirman Kav. 61-62
Jakarta-12190 Indonesia
Tel: (021) 5220785, 2526841
Fax: (021) 5202041
E-mail: itsf@ina.toray.co.id
Homepage: http://www.itsf.or.id
ITSF
INDONESIA TORAY SCIENCE FOUNDATION
AWARD
2013
20th
NOMINATION FORM
SCIENCE AND TECHNOLOGY AWARD
DATE
:
TO
: INDONESIA TORAY SCIENCE FOUNDATION
Summitmas II – 3rd Floor
Jl. Jenderal Sudirman Kav. 61-62
Jakarta Selatan 12190
Tel
: (021) 5220785, 2526841
Fax
: (021) 5202041
Homepage
: http://www.itsf.or.id
Email
: itsf@ina.toray.co.id
(This form should be completed, typed or printed in English. Use a separate form for each nomination. You need not use this
form if you can re-produced and complete it in the same format using a photocopier or a word processor).
Please read the guidelines and this form carefully before you fill in the form.
Failure in submitting necessary attachment will result in the nomination not being considered.
A recent photograph of the candidate should be attached.
The proposal with all necessary attachments should be nicely bound with transparent plastic cover,
and send 5 (five) copies to ITSF at the mailing address stated herein.
Particulars of Nomination Institution
Name of Institution
:
(should be a Researcher Center or a Faculty for University or a Research Center
(Puslit) for Non-university institution)
Address
:
Province
:
Post Code:
Telephone
: (…..)
Fax: (…..)
Email address
:
Name & Title of Representative :
(Chairman/Dean/Director)*
*) choose the appropriate one
-1-
I nominate this candidate for the ITSF Science & Technology Award on the basis of
the following contribution of the candidate, leading to a significant breakthrough in
his/her field of study.
(
)
Signature of the representative
of the nominating institution
Date
-2-
PARTICULARS OF CANDIDATE
Name & Title
:
Place & Date of Birth
:
Sex
: Male
Name of Institution
:
Position of Candidate
:
Address of Institution
:
Province
:
Post Code
Telephone
: (……)
Fax
Province
:
Post Code
Telephone
: (…..)
Fax
: (…..)
Handphone
:
Email
:
PHOTO
Size 4x6
should be
attached here
Female
:
: (…..)
Home Address :
Field of Focus Research
:
Title of the Research Area
:
:
Please, describe your research maximum 100 words, which cover as follows
- Key technology
:
- Purpose
:
- Result
:
- Impact
:
(
)
Signature of the Candidate
-3-
PREVIOUS ACHIEVEMENTS
Please, state whether any award has been received within the last two years:
Yes:
/
No:
If yes,
When
:
From
:
Type of Award
:
Rp/US$
:
-4-
Detailed description of contribution to scientific knowledge leading to a significant
breakthrough in the field of study
-5-
Detailed publications related to the above achievements
Please list the publications in the following format:
Author(s); Year; Title of Article; Name of Scientific Journal; Volume, and page numbers
Data on citation index of your publications will be helpful for quality assessment of the
publications. Please indicate minimum 2 (two) of main publications (marked by an asterisk)
and submit 1 (one) copy each of two main publications and bound to the proposal. Failure
to do this may result in a non-consideration of the nomination.
-6-
Biodata of the Candidate
Please include information regarding the educational and research experiences.
The degree(s) obtained should be mentioned in detail including the title(s), the year, and the
place/university. If necessary, attach the copy of the thesis and or dissertation.
-7-